Carnitine supplement may improve survival rates of children with heart defects

World first clinical trial supports use of Kava to treat anxiety

Statins block the ability of exercise to improve fitness levels

Expert questions US public health agency advice on influenza vaccines

Vitamin C may head off lung problems in babies born to pregnant smokers

Infants born to women who took vitamin C during pregnancy had less wheezing in first year of life than babies whose moms took a placebo

WASHINGTON, DC – Pregnant women are advised not to smoke during pregnancy because it can harm the baby’s lungs and lead to wheezing and asthma, among other problems. If a woman absolutely can’t kick the habit, taking vitamin C during pregnancy may improve her newborn’s lung function and prevent wheezing in the first year of life, according to a study to be presented Saturday, May 4, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.

“Vitamin C is a simple, safe and inexpensive treatment that may decrease the impact of smoking during pregnancy on childhood respiratory health,” said lead author Cynthia T. McEvoy, MD, MCR, FAAP, associate professor of pediatrics at Oregon Health & Science University (OHSU) Doernbecher Children’s Hospital.

The study included 159 women who were less than 22 weeks pregnant and were unable to quit smoking. Participants were randomly assigned to take either one 500 milligram capsule of vitamin C or a placebo each day with a prenatal vitamin. Neither the study investigator nor the women knew what was in the capsule they were taking. A group of nonsmoking pregnant women also was studied.

Investigators tested the newborns’ pulmonary function at about 48 hours of life. They measured how the newborn breathed in and out, how easily the baby’s lungs moved and how big the baby’s lungs were. Results showed that babies born to smoking women who took vitamin C had significantly improved lung function at birth compared to babies whose mothers took a placebo.

The researchers also contacted the parents through the infants’ first year of life to document any episodes of wheezing and other respiratory symptoms. They found that infants whose mothers were in the vitamin C group had significantly less wheezing through 1 year of age than the infants whose moms had received the placebo.

Specifically, 21 percent of infants in the vitamin C group had at least one episode of wheezing compared to 40 percent of those in the placebo group and 27 percent of infants born to nonsmokers. In addition, 13 percent of infants whose mothers were randomized to vitamin C needed medication for their wheezing compared to 22 percent of infants in the placebo group and 10 percent in the nonsmoking group.

“Getting women to quit smoking during pregnancy has to be priority one, but this finding provides a way to potentially help the infants born of the roughly 50 percent of pregnant smokers who won’t or just can’t quit smoking no matter what is tried,” said study co-author Eliot Spindel, MD, PhD, senior scientist at the Oregon National Primate Research Center at OHSU.

In addition, the researchers also found that one genetic variant shown to increase the risk of smokers developing cancer and associated with reduced ability to quit smoking and high likelihood of relapse seemed to intensify the harmful effects of maternal smoking on how the baby’s lungs formed, Dr. McEvoy said.

“Though the lung function of all babies born to smokers in our study was improved by supplemental vitamin C,” she said, “our preliminary data suggest that vitamin C appeared to help those babies at the greatest risk of harm during their development from their mother’s smoking in pregnancy.”

WASHINGTON, DC – Parents are advised to make sure their children drink milk and eat other calcium-rich foods to build strong bones. Soon, they also may be urged to make sure their kids eat salmon, almonds and other foods high in magnesium — another nutrient that may play an important role in bone health, according to a study to be presented Sunday, May 5, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.

“Lots of nutrients are key for children to have healthy bones. One of these appears to be magnesium,” said lead author Steven A. Abrams MD, FAAP, professor of pediatrics at Baylor College of Medicine in Houston. “Calcium is important, but, except for those children and adolescents with very low intakes, may not be more important than magnesium.”

While it is known that magnesium is important for bone health in adults, few studies have looked at whether magnesium intake and absorption are related to bone mineral content in young children. This study aimed to fill that gap.

Researchers recruited 63 healthy children ages 4 to 8 years old who were not taking any multivitamins or minerals to participate in the study. Children were hospitalized overnight twice so their calcium and magnesium levels could be measured.

Participants filled out food diaries prior to hospitalization. All foods and beverages served during their hospital stay contained the same amount of calcium and magnesium they consumed in a typical day based on the diaries. Foods and beverages were weighed before and after each meal to determine how much calcium and magnesium the subjects actually consumed. In addition, parents were given scales to weigh their child’s food for three days at home after the first inpatient stay and for three days at home prior to the second inpatient stay so that dietary intake of calcium and magnesium could be calculated accurately.

While hospitalized, children’s levels of calcium and magnesium were measured using a technique that involved giving them non-radioactive forms of magnesium and calcium, called stable isotopes, intravenously and orally. Urine was collected for 72 hours. By measuring the stable isotopes in the urine, the researchers could determine how much calcium and magnesium were absorbed into the body. Bone mineral content and density were measured using total body dual-energy X-ray absorptiometry.

Results showed that the amounts of magnesium consumed and absorbed were key predictors of how much bone children had. Dietary calcium intake, however, was not significantly associated with total bone mineral content or density.

“We believe it is important for children to have a balanced, healthy diet with good sources of minerals, including both calcium and magnesium,” Dr. Abrams concluded.

Preterm infants may need 800 IU of vitamin D3 per day

Largest study to date of preemies shows 800 IU more effective than 400 IU in decreasing vitamin D insufficiency

WASHINGTON, DC – Preterm infants may need to be given 800 international units (IU) of vitamin D a day to ensure they develop strong bones, according to a study to be presented Sunday, May 5, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC.

Preemies are known to be at risk for vitamin D insufficiency. If levels of vitamin D are too low, infants and children can get rickets, which leads to softening and weakening of the bones.

Recommendations from medical organizations on how much vitamin D should be given to preemies range from 400 IU to 1000 IU per day. This lack of consensus prompted researchers from All India Institute of Medical Sciences, New Delhi, to conduct the largest study to date on vitamin D supplementation in preterm infants.

Subjects included 96 infants born between 28 and 34 weeks’ gestation who were receiving milk feeding. Blood samples were taken from the infants to determine their serum vitamin D levels. The infants then were randomly assigned to receive either 800 IU or 400 IU of oral vitamin D3. Neither the parents nor the primary investigator was aware of which dose the infants were receiving.

Researchers compared whether the prevalence of vitamin D insufficiency (VDI) at 40 weeks and at 3 months corrected age differed between the groups. They also looked at whether infants with higher vitamin D levels also had stronger bones at 3 months corrected age and whether supplementation led to vitamin D levels that were too high.

Results showed that VDI was common in both groups before they received supplements (79 percent of the 800 IU group and 83 percent of the 400 IU group).

After supplementation, the prevalence of VDI at 40 weeks was 43 percent lower in the 800 IU group than the 400 IU group (38 percent vs. 67 percent). In addition, VDI was significantly lower in the 800 IU group when the infants were 3 months old (12 percent vs. 35 percent).

Four infants needed to be supplemented with 800 IU daily to reduce one case of vitamin D insufficiency, said lead author Chandra Kumar Natarajan, DM.

“The study results show conclusively that in preterm infants with high rates of vitamin D insufficiency at baseline, supplementation with 800 IU of vitamin D3 per day compared to 400 IU per day reduces vitamin D insufficiency at term equivalent age and at 3 months,” Dr. Natarajan said. “There also is a trend toward a decrease in the prevalence of vitamin D insufficiency even in the 400 IU group at 3 months. Therefore, 400 IU per day may be sufficient after 3 months.”

Despite significant improvement in serum vitamin D levels in the 800 IU group, higher levels did not result in better bone mineralization at 3 months of age as measured by dual energy X-ray absorptiometry (DEXA). In addition, weight, length and head circumference did not differ significantly between the groups.

Dr. Natarajan also noted that one infant in the 800 IU group had vitamin D levels that were higher than recommended levels at 3 months of age despite the levels at term age being normal. Excess vitamin D for at least one month can cause decreased muscle tone, decreased appetite, irritability and constipation, among other problems. The infant did not experience any major effects.

“The incidence of vitamin D excess in the 800 IU group may indicate the need for monitoring vitamin D levels in infants on vitamin D supplementation, but we need larger studies to answer this,” he said. “Similarly, larger studies with longer duration of follow-up may be needed to find out any meaningful difference in clinical outcomes such as bone mineralization.”

Parents who suck on their infants’ pacifiers may protect their children against developing allergy

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, Sweden, report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the baby’s pacifier.

Allergies are very common in industrialized countries. It has been suggested that exposure to harmless bacteria during infancy may be protective against the development of allergy. However, it has been difficult to pinpoint which bacteria a baby should be exposed to, and at what time and by which route this exposure should ideally occur.

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, now report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the baby’s pacifier.

In a group of 184 children, who were followed from birth, the researchers registered how many infants used a pacifier in the first 6 months of life and how the parents cleaned the pacifier. Most parents rinsed the pacifier in tap water before giving it to the baby, e.g., after it had fallen on the floor. However, some parents also boiled the pacifier to clean it. Yet other parents had the habit of putting the baby’s pacifier into their mouth and cleaning it by sucking, before returning it to the baby.

It was found that children whose parents habitually sucked the pacifier were three times less likely to suffer from eczema at 1.5 years of age, as compared with the children of parents who did not do this. When controlled for other factors that could affect the risk of developing allergy, such as allergy in the parents and delivery by Caesarean section, the beneficial effect of parental sucking on the pacifier remained.

Pacifier use per se had no effect on allergy development in the child. Boiling the pacifier also did not affect allergy development in a statistically proven fashion.

No more upper respiratory infections were seen in the children whose parents sucked on their dummies, as compared with the other children, as evidenced by diaries kept by the parents in which they noted significant events, such as infections.

Saliva is a very rich source of bacteria and viruses, and the researchers believe that oral commensal microbes are transferred from parent to infant when they suck on the same pacifier. When the composition of the bacterial flora in the mouth was compared between infants whose parents sucked on their pacifiers and those whose parent did not, it was found to differ, supporting this hypothesis.

According to “the hygiene hypothesis”, the development of allergy can be attributed in part to a paucity of microbial stimulation during early infancy.

The study, which is published in the scientific journal Pediatrics, was performed by a team that consisted of paediatricians specialized in allergic diseases, as well as microbiologists and immunologists. The research team has previously conducted large-scale studies on the gut microbiota in relation to allergy development and showed in 2009 that a complex gut microbiota very early in life reduces the risk of allergy development.

Johns Hopkins researchers believe they may have discovered an explanation for the sleepless nights associated with restless legs syndrome (RLS), a symptom that persists even when the disruptive, overwhelming nocturnal urge to move the legs is treated successfully with medication.

Neurologists have long believed RLS is related to a dysfunction in the way the brain uses the neurotransmitter dopamine, a chemical used by brain cells to communicate and produce smooth, purposeful muscle activity and movement. Disruption of these neurochemical signals, characteristic of Parkinson’s disease, frequently results in involuntary movements. Drugs that increase dopamine levels are mainstay treatments for RLS, but studies have shown they don’t significantly improve sleep. An estimated 5 percent of the U.S. population has RLS.

The small new study, headed by Richard P. Allen, Ph.D., an associate professor of neurology at the Johns Hopkins University School of Medicine, used MRI to image the brain and found glutamate — a neurotransmitter involved in arousal — in abnormally high levels in people with RLS. The more glutamate the researchers found in the brains of those with RLS, the worse their sleep.

The findings are published in the May issue of the journal Neurology.

“We may have solved the mystery of why getting rid of patients’ urge to move their legs doesn’t improve their sleep,” Allen says. “We may have been looking at the wrong thing all along, or we may find that both dopamine and glutamate pathways play a role in RLS.”

For the study, Allen and his colleagues examined MRI images and recorded glutamate activity in the thalamus, the part of the brain involved with the regulation of consciousness, sleep and alertness. They looked at images of 28 people with RLS and 20 people without. The RLS patients included in the study had symptoms six to seven nights a week persisting for at least six months, with an average of 20 involuntary movements a night or more.

The researchers then conducted two-day sleep studies in the same individuals to measure how much rest each person was getting. In those with RLS, they found that the higher the glutamate level in the thalamus, the less sleep the subject got. They found no such association in the control group without RLS.

Previous studies have shown that even though RLS patients average less than 5.5 hours of sleep per night, they rarely report problems with excessive daytime sleepiness. Allen says the lack of daytime sleepiness is likely related to the role of glutamate, too much of which can put the brain in a state of hyperarousal — day or night.

If confirmed, the study’s results may change the way RLS is treated, Allen says, potentially erasing the sleepless nights that are the worst side effect of the condition. Dopamine-related drugs currently used in RLS do work, but many patients eventually lose the drug benefit and require ever higher doses. When the doses get too high, the medication actually can make the symptoms much worse than before treatment. Scientists don’t fully understand why drugs that increase the amount of dopamine in the brain would work to calm the uncontrollable leg movement of RLS.

Allen says there are already drugs on the market, such as the anticonvulsive gabapentin enacarbil, that can reduce glutamate levels in the brain, but they have not been given as a first-line treatment for RLS patients.

RLS wreaks havoc on sleep because lying down and trying to relax activates the symptoms. Most people with RLS have difficulty falling asleep and staying asleep. Only getting up and moving around typically relieves the discomfort. The sensations range in severity from uncomfortable to irritating to painful.

“It’s exciting to see something totally new in the field — something that really makes sense for the biology of arousal and sleep,” Allen says.

As more is understood about this neurobiology, the findings may not only apply to RLS, he says, but also to some forms of insomnia.

Carnitine supplement may improve survival rates of children with heart defects

AUGUSTA, Ga. – A common nutritional supplement may be part of the magic in improving the survival rates of babies born with heart defects, researchers report.

Carnitine, a compound that helps transport fat inside the cell powerhouse where it can be used for energy production, is currently used for purposes ranging from weight loss to chest pain.

New research shows it appears to normalize the blood vessel dysfunction that can accompany congenital heart defects and linger even after corrective surgery, said Dr. Stephen M. Black, cell and molecular physiologist at the Vascular Biology Center at the Medical College of Georgia at Georgia Regents University.

“My hope is this is going to have a major, major impact on survival of babies,” Black said. About half the babies born with heart defects have excessive, continuous high pressure on their lungs from misdirected blood flow. Early surgery can prevent full-blown pulmonary vascular disease, but scientists are finding more subtle disruptions in the signaling inside blood vessels walls that can be problematic – even deadly – up to 72 hours after surgery.

The good news is the changes are reversible and that carnitine speeds recovery and can even prevent the damage in a lamb model of these human heart defects, according to studies published in the journal Pediatric Research.

Normally, most blood flow bypasses the lungs in utero when the placenta provides blood and oxygen for the baby. Baby’s first breaths naturally expand the lungs and blood vessels, activating a process inside the lining of vessels that enables them to accommodate the initial blood surge, then reduce pressure quickly, dramatically and permanently.

This natural transition doesn’t occur when heart defects misdirect blood flow. “It’s kind of like a chronic fetal-to-newborn transition,” said Black, the study’s corresponding author. Lungs get pounded with about three times the normal flow and, even when surgeries are done as early as possible to repair the defect, correct blood flow and protect the lungs, the 20 percent death rates from acute pulmonary hypertension have remained unchanged for a decade. “That’s 1 in 5 kid (with this condition),” Black said.

Left unchecked, the barrage thickens blood vessels, making them unresponsive, much like those of an elderly individual who has lived for years with uncontrolled high blood pressure. The comparatively brief periods of pounding these babies experience impairs the ability of the endothelial cells, which line blood vessels, to produce nitric oxide, a major dilator of blood vessels.

The shear force disrupts carnitine homeostasis, weakens the mitochondria (the cell powerhouse) and impairs nitric oxide production. To make bad matters worse, the precursor to nitric oxide instead makes more peroxynitrite, prompting endothelial cells to grow and thickening blood vessels. Black was also corresponding author of a recent study in the Journal of Biological Chemistry that showed peroxynitrite does this by turning on the cell survival protein kinase Akt1.

The new study indicates that even without fixing the heart defect, high daily doses of carnitine in the first four weeks of life can prevent endothelial dysfunction. In fact, the laboratory lambs’ ability to make nitric oxide is preserved even without the benefit of heart surgery and the responses to the chemical activity that enables blood vessel dilation is normalized, Black said.

Study co-author Dr. Jeffrey Fineman, a whole-animal physiologist and physician at the University of California, San Francisco, developed the model, a lamb whose four-chambered heart is very similar to humans. In utero surgery that misdirects too much blood to the lungs, means that, like children, the lambs are born with the defect.

Black is now working with Fineman, who is pursuing additional funding to resolve questions such as the optimal dosage and timing for giving carnitine. “Do you want to give it for six weeks when you only have to give it for six hours?” Black said. The researchers also plan to examine carnitine homeostasis in the blood of children with heart defects to see if it’s disrupted. If it is, they plan to start clinical trials.

About 1 in 125 babies are born with a heart defect each year in the United States, according to the March of Dimes. The research was funded by the National Institutes of Health, the Foundation Leducq and the American Heart Association.

World first clinical trial supports use of Kava to treat anxiety

A world-first completed clinical study by an Australian team has found Kava, a medicinal South Pacific plant, significantly reduced the symptoms of people suffering anxiety.

The study, led by the University of Melbourne and published in the Journal of Clinical Psychopharmacology, revealed Kava could be an alternative treatment to pharmaceutical products for the hundreds of thousands of Australians who suffer from Generalised Anxiety Disorders (GAD)

Lead researcher, Dr Jerome Sarris from Department of Psychiatry at the University of Melbourne, said GAD is a complex condition that significantly affected people’s day-today lives. Existing medications have a modest clinical effect and new effective options were needed for patients with anxiety.
“Based on previous work we have recognised that plant based medicines may be a viable treatment for patients with chronic anxiety. In this study we’ve been able to show that Kava offers a potential natural alternative for the treatment of chronic clinical anxiety. Unlike some other options it has less risk of dependency and less potential for side effects,” he said.

The study also found that people’s genetic differences (polymorphisms) of certain neurobiological mechanisms called GABA transporters, may modify their response to Kava.
“If this finding is replicated, it may pave the way for simple genetic tests to determine which people may be likely to have a beneficial anxiety-reducing effect from taking Kava,” Dr Sarris said.

During the eight-week study, 75 patients with clinically diagnosed Generalised Anxiety Disorder were given Kava or placebo, and anxiety levels were regularly assessed.
Results showed a significant reduction in anxiety for the Kava group compared to the placebo group at the end of the study.

In participants diagnosed with moderate to severe GAD, Kava had an even greater effect in reducing anxiety. Following the completion of the controlled phase, 26 per cent of the Kava group were classified as in remission from their symptoms compared to six per cent of the placebo group.

Participants in the Kava group were given tablets twice per day consisting of water-soluble extracted Kava (peeled rootstock) for a total dose of 120mg of kavalactones for the first three-week controlled phase. In cases of non-response this was increased to a double-dose twice per day for the second three-week controlled phase. Participants in the placebo group took matching dummy tablets in the same manner.

Kava was also well tolerated. Results showed no significant differences across the two groups for liver function which had previously been a concern for Kava’s medicinal use. In addition there were no considerable adverse reactions that could be attributed to Kava and no difference in withdrawal or addiction between the groups.

An additional novel finding of the study, recently published in Phytotherapy Research was that Kava increased women’s sex drive compared to those in the placebo group, believed to be due to the reduction of anxiety, rather than any aphrodisiac effect.

Future studies confirming the genetic relationship to therapeutic response, and any libido-improving effects from Kava is now required. Dr Sarris said these significant findings are of importance to sufferers of anxiety and to the South Pacific region which relies on Kava as a major export.

The study was funded by the NHMRC and Integria Healthcare who manufacture MediHerb and Thompson’s Kava products

Statins block the ability of exercise to improve fitness levels

COLUMBIA, Mo. – Statins, the most widely prescribed drugs worldwide, are often suggested to lower cholesterol and prevent heart disease in individuals with obesity, diabetes and metabolic syndrome, which is a combination of medical disorders including excess body fat and/or high levels of blood pressure, blood sugar and/or cholesterol. However, University of Missouri researchers found that simvastatin, a generic type of statin previously sold under the brand name “Zocor,” hindered the positive effects of exercise for obese and overweight adults.

“Fitness has proven to be the most significant predictor of longevity and health because it protects people from a variety of chronic diseases,” said John Thyfault, an associate professor of nutrition and exercise physiology at MU. “Daily physical activity is needed to maintain or improve fitness, and thus improve health outcomes. However, if patients start exercising and taking statins at the same time, it seems that statins block the ability of exercise to improve their fitness levels.”

Thyfault says many cardiologists want to prescribe statins to all patients over a certain age regardless of whether they have metabolic syndrome; the drugs also are recommended for people with Type 2 diabetes. He recommends that cardiologists more closely weigh the benefits and risks of statins given this new data about their effect on exercise training.

“Statins have only been used for about 15-20 years, so we don’t know what the long-term effects of statins will be on aerobic fitness and overall health,” Thyfault said. “If the drugs cause complications with improving or maintaining fitness, not everyone should be prescribed statins.”

Thyfault and his colleagues measured cardiorespiratory fitness in 37 previously sedentary, obese individuals ages 25-59 with low fitness levels. The participants followed the same exercise regimen on the MU campus for 12 weeks; 18 of the 37 people also took 40 mg of simvastatin daily.

Statins significantly affected participants’ exercise outcomes. Participants in the exercise-only group increased their cardiorespiratory fitness by an average of 10 percent compared to a 1.5 percent increase among participants also prescribed statins. Additionally, skeletal muscle mitochondrial content, the site where muscle cells turn oxygen into energy, decreased by 4.5 percent in the group taking statins while the exercise-only group had a 13 percent increase, a normal response following exercise training.

Thyfault suggests that future research determine whether lower doses of simvastatin or other types of statins similarly affect people’s exercise outcomes and thus their risk for diseases such as Type 2 diabetes. Starting a statin regimen after exercising and obtaining a higher fitness level may reduce the drugs’ effects on fitness, he says.

The study, “Simvastatin impairs exercise training adaptations,” was published in the Journal of the American College of Cardiology. Co-authors included first author Catherine Mikus, who is now a postdoctoral fellow at Duke University, and MU researchers Leryn Boyle, Douglas Oberlin, Scott Naples, Justin Fletcher, Harold Laughlin, Kevin Dellsperger and Paul Fadel. Funding was provided by a grant from the MU Research Board, the Veterans Affairs’ Career Development Award, an American Heart Association Midwest Affiliate Clinical Research Award and the National Institutes of Health. The Department of Nutrition and Exercise Physiology is jointly administered by the College of Agriculture, Food and Natural Resources, the College of Human Environmental Sciences and the School of Medicine. Thyfault has a joint appointment in the Department of Internal Medicine in the Division of Gastroenterology and Hepatology in the MU School of Medicine.

Promotion of influenza vaccines is one of the most visible and aggressive public health policies today, writes Doshi. Today around 135 million doses of influenza vaccine annually enter the US market, with vaccinations administered in drug stores, supermarkets – even some drive-throughs.

This enormous growth has not been fuelled by popular demand but instead by a public health campaign that delivers a straightforward message: influenza is a serious disease, we are all at risk of complications from influenza, the flu shot is virtually risk free, and vaccination saves lives.

Yet, Doshi argues that the vaccine might be less beneficial and less safe than has been claimed, and the threat of influenza appears overstated.

To support its case, the CDC cites two studies of influenza vaccines, published in high-impact, peer-reviewed journals and carried out by academic and government researchers with non-commercial funding. Both found a large (up to 48%) relative reduction in the risk of death.

“If true, these statistics indicate that influenza vaccines can save more lives than any other single licensed medicine on the planet,” says Doshi. But he argues that these studies are “simply implausible” and likely the product of the ‘healthy-user effect’ (in this case, a propensity for healthier people to be more likely to get vaccinated than less healthy people).

In addition, he says, there is virtually no evidence that influenza vaccines reduce elderly deaths – the very reason the policy was originally created.

He points out that the agency itself acknowledges the evidence may be undermined by bias. Yet, he says “for most people, and possibly most doctors, officials need only claim that vaccines save lives, and it is assumed there must be solid research behind it.”

He also questions the CDC’s recommendation that beyond those for whom the vaccine is contraindicated, influenza vaccine can only do good, pointing to serious reactions to influenza vaccines in Australia (febrile convulsions in young children) and Sweden and Finland (a spike in cases of narcolepsy among adolescents).

Doshi suggests that influenza is yet one more case of “disease mongering” – medicalising ordinary life to expand markets for new products. But, he warns that unlike most stories of selling sickness, “here the salesmen are public health officials, worried little about which brand of vaccine you get so long as they can convince you to take influenza seriously.”

But perhaps the cleverest aspect of the influenza marketing strategy surrounds the claim that “flu” and “influenza” are the same, he concludes. “All influenza is “flu,” but only one in six “flus” might be influenza. It’s no wonder so many people feel that “flu shots” don’t work: for most flus, they can’t.”

Earlier this year, the BMJ launched a ‘Too Much Medicine’ campaign to help tackle the threat to health and the waste of money caused by unnecessary care. The journal will also partner at an international conference Preventing Overdiagnosis to be held in September in the USA.

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